In Canada today, prisoners who inject drugs need to share needles, many of which have been used numerous times by other prisoners. Without access to sterile injection equipment, rates of HIV and hepatitis C virus are much higher behind bars than in the broader community. Prison-based needle and syringe programs (PNSPs) are an important way to address this public health problem, yet Canadian correctional authorities often claim they won’t work. A recent study demonstrates that PNSPs are indisputably feasible in Canada and should be implemented now.
A new report, On Point: Recommendations for Prison-Based Needle and Syringe Programs in Canada, outlines the findings of a two-year study that involved consultation with a range of diverse stakeholders, including former prisoners themselves. The research was conducted by representatives from the Department of Criminology at Ryerson University, PASAN (a community-based AIDS service organization that provides community development, education, and support to prisoners and ex-prisoners in Ontario), and the Canadian HIV/AIDS Legal Network (one of the world’s leading organizations tackling the legal and human rights issues related to HIV).
In an era where sometimes difficult, science-based decisions are routinely required of both positive and negative individuals− think when to start treatment, or the relative benefits of PrEP vs condoms− are we doing enough to steer people away from bad decisions?
First we need to acknowledge that even in a non-judgmental environment such as ours, some decisions just aren’t wise. Charlie Sheen and the allure of the goat’s milk cure proved that quite publicly. So did this Facebook commenter opining recently when to start treatment: “It’s best to wait until there is a patch, a spray or a cure.” In fact I suspect there is a fairly large faction (I call them “treatment denialists” ) who aren’t persuaded by START that early treatment works best. Or by PARTNER that it can all but eliminate the risk of transmission.
Over the past year, advocates or elected officials in Montreal, Ottawa, Victoria, Baltimore, New York City, Ithaca (NY), Seattle, San Francisco, Glasgow and four cities in Ireland have called for the implementation of supervised injection services. More recently, Toronto’s Medical Officer of Health Dr. David McKeown recommended that the Board of Health start a community consultation process toward establishing supervised injection services within three existing facilities in the city. The Board voted unanimously in favour. As the lead investigators of the TOSCA study (the Toronto and Ottawa Supervised Consumption Assessment), we support Dr. McKeown’s proposal and look forward to the opening of these services in Toronto.
My daughter has a smartphone cover that says: “We’re all mad here”. It’s from Alice in Wonderland. I like it; and when it comes to hepatitis C treatment and pricing, it’s quite on point.
In 2014, Canada and the rest of the world turned a miraculous corner – a cure for viral hepatitis C was on the market. Wonderful and amazing. Why? Well, viral hepatitis C is the only chronic viral infection that now has a cure – that is, a cure for virtually everyone, with a cure rate of 95 per cent.
One of the most memorable moments in my 20 years working in the HIV field happened in a standing-room-only meeting hall in Vienna at the International AIDS Conference in 2010. This was the moment that the clinical trial CAPRISA 004 announced proof-of-concept for prevention of HIV among women using a vaginal microbicide (1% tenofivir gel). The entire room broke out in a standing ovation and tears of joy. Finally! A prevention tool that could allow a woman to protect herself in sexual encounters, regardless of the desires and wishes of her sexual partner. Five years later, microbicides have not yet come to fruition. But pre-exposure prophylaxis (PrEP) holds the same great promise.
The CATIE Blog is written for people and organizations working and volunteering in Canada’s response to HIV and hepatitis C and hosts the views and opinions of frontline service providers.